Comorbidities may impact survival and choice of treatment amongst cancer patients. In fact, comorbidities have been identified as significant determinants of response to therapy in older patients with acute myeloid leukemia, breast cancer, head and neck, and lung cancer. Charlson comorbidity index and adult comorbidity evaluation-27 are lists of comorbidities with a weight assigned from 1 to 6 for the former and from 0 to 3 for the latter score, derived from relative risk estimates of a proportional hazard regression model using clinical data. Design and Methods. We retrospectively evaluated the impact of Charlson index and adult comorbidity evaluation-27 in a cohort of 125 elderly (> 60 years) chronic phase chronic myeloid leukemia patients who received dasatinib after imatinib resistance or intolerance with the aim to establish associations between comorbidities and development of pleural effusions or compliance to the drug. Results. We found a significant association between Charlson index as well as adult comorbidity evaluation-27 and drug reduction or suspension rate: with Charlson, 49% of score 0 patients experienced a reduction of the dose compared to 63% of patients with score 1, 74% of patients with score 2 and 100% of patients with score 3-5 (p=0.03); with adult index, 45% of patients had score 0-1 and 69% of patients with score 2-3 experienced a reduction of the dose. Of the 65 patients with Charlson score 0, 29% had at least one suspension (79% for hematologic and 21% for non-hematologic toxicity, respectively), compared to 46% of patients with score 1 (37% for hematologic and 69% for non-hematologic toxicity), 58% of patients with score 2 (36% for hematologic and 64% for non-hematologic toxicity) and 100% of patients with score 3 and 4 (all patients for both types of toxicity). High scores according to adult comorbidity index-27 identified patients at high risk of grade 3/4 hematologic toxicity. Forty-one patients (32.8%) experienced pleural effusion during treatment: for either indexes, the highest scores were associated to increased risk of pleural effusions. Conclusions. In elderly chronic myeloid leukemia patients treated with dasatinib, the rate of drug reduction or suspension and the incidence of pleural effusions seem to be associated with the presence of comorbidities: the stratification according to Charlson and adult comorbidity evaluation-27 before dasatinib therapy may allow to identify patients at risk of having major toxicities.
Charlson comorbidity index and adult comorbidity evaluation-27 might predict compliance and development of pleural effusions in elderly chronic myeloid leukemia patients treated with dasatinib after resistance/intolerance to imatinib.
CAVAZZINI, Francesco;
2011
Abstract
Comorbidities may impact survival and choice of treatment amongst cancer patients. In fact, comorbidities have been identified as significant determinants of response to therapy in older patients with acute myeloid leukemia, breast cancer, head and neck, and lung cancer. Charlson comorbidity index and adult comorbidity evaluation-27 are lists of comorbidities with a weight assigned from 1 to 6 for the former and from 0 to 3 for the latter score, derived from relative risk estimates of a proportional hazard regression model using clinical data. Design and Methods. We retrospectively evaluated the impact of Charlson index and adult comorbidity evaluation-27 in a cohort of 125 elderly (> 60 years) chronic phase chronic myeloid leukemia patients who received dasatinib after imatinib resistance or intolerance with the aim to establish associations between comorbidities and development of pleural effusions or compliance to the drug. Results. We found a significant association between Charlson index as well as adult comorbidity evaluation-27 and drug reduction or suspension rate: with Charlson, 49% of score 0 patients experienced a reduction of the dose compared to 63% of patients with score 1, 74% of patients with score 2 and 100% of patients with score 3-5 (p=0.03); with adult index, 45% of patients had score 0-1 and 69% of patients with score 2-3 experienced a reduction of the dose. Of the 65 patients with Charlson score 0, 29% had at least one suspension (79% for hematologic and 21% for non-hematologic toxicity, respectively), compared to 46% of patients with score 1 (37% for hematologic and 69% for non-hematologic toxicity), 58% of patients with score 2 (36% for hematologic and 64% for non-hematologic toxicity) and 100% of patients with score 3 and 4 (all patients for both types of toxicity). High scores according to adult comorbidity index-27 identified patients at high risk of grade 3/4 hematologic toxicity. Forty-one patients (32.8%) experienced pleural effusion during treatment: for either indexes, the highest scores were associated to increased risk of pleural effusions. Conclusions. In elderly chronic myeloid leukemia patients treated with dasatinib, the rate of drug reduction or suspension and the incidence of pleural effusions seem to be associated with the presence of comorbidities: the stratification according to Charlson and adult comorbidity evaluation-27 before dasatinib therapy may allow to identify patients at risk of having major toxicities.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
